新辅助直肠评分对于局部进展期直肠癌的生存预测研究  

Study of the prognostic value of neoadjuvant rectal scores for survival in locally advanced rectal cancer

作　　者：侯海玲 韩好男 刘苗 杨艳玲 徐利明 Hou Hailing;Han Haonan;Liu Miao;Yang Yanling;Xu Liming(Department of Radiation Oncology,Tianjin Medical University Cancer Institute&Hospital,National Clinical Research Center for Cancer,Tianjin's Clinical Research Center for Cancer,Tianjin Key Laboratory of Digestive Cancer,Tianjin 300060,China;Hubei Key Laboratory of Tumor Microenvironment and Immunotherapy,College of Basic Medical Sciences,China Three Gorges University,Yichang 443002,China)

机构地区：[1]天津医科大学肿瘤医院放疗科,国家恶性肿瘤临床医学研究中心,天津市恶性肿瘤临床医学研究中心,天津市消化系统肿瘤重点实验室,天津300060 [2]三峡大学基础医学院,肿瘤微环境与免疫治疗湖北省重点实验室,宜昌443002

出　　处：《中华放射肿瘤学杂志》2025年第2期144-150,共7页Chinese Journal of Radiation Oncology

基　　金：国家自然科学基金(82373194);天津市医学重点学科(专科)建设项目(TJYXZDXK-009A)。

摘　　要：目的探讨并验证新辅助直肠(NAR)评分用于中低位局部进展期直肠癌患者预后预测的价值。方法回顾性分析2015年1月至2021年12月天津医科大学肿瘤医院收治的中低位局部进展期直肠腺癌新辅助放化疗患者207例。新辅助放疗方案为盆腔外照射45~50.4 Gy,1.8 Gy/次,5次/周,于放疗的第1~14天、第22~36天同步口服卡培他滨化疗,后续行全系膜切除(TME)手术。根据初始临床分期及术后病理分期计算NAR评分,将NAR评分以<8、8~16及>16分分为低、中、高三层。应用Kaplan-Meier法计算3年无瘤生存(DFS)及总生存(OS),log-rank法比较不同NAR分层患者DFS和OS的差别。部分患者在同步放化疗-手术间隔期间接受了巩固化疗,甚至是全新辅助治疗(TNT),亚组分析进一步验证NAR评分在强化新辅助治疗模式下的预测价值。结果全组患者中位随访46.0个月(范围:19.5~88.0个月),3年DFS率为79.2%,3年OS率为87.4%。单因素分析发现NAR评分对3年DFS及OS均有显著影响。NAR评分低、中、高的患者3年DFS率分别为90.3%、86.1%和58.7%(P<0.001),3年OS率分别为94.4%、91.7%和74.6%(P<0.001)。亚组分析结果显示,NAR评分的预测价值同样适用于强化新辅助治疗模式,低、中、高评分患者3年的DFS分别为86.9%、83.8%和68.3%(P=0.044),3年的OS率分别为92.9%、90.7%和85.4%(P=0.029)。结论中低位局部进展期直肠腺癌无论是新辅助治疗还是强化新辅助治疗后TME手术,NAR评分均可有效预测患者预后。Objective To explore and verify the value of neoadjuvant rectal(NAR)score in predicting the prognosis of patients with middle and low locally advanced rectal cancer.Methods A retrospective analysis of 207 patients with middle and low locally advanced rectal adenocarcinoma who received neoadjuvant radiotherapy and chemotherapy in Tianjin Medical University Cancer Institute&Hospital from January 2015 to December 2021 was performed.The neoadjuvant radiotherapy regimen was pelvic external irradiation of 45-50.4 Gy,1.8 Gy/f,5 times per week and concurrent oral capecitabine chemotherapy on days 1-14 and 22-36 during radiotherapy.Total mesorectal excision(TME)was then performed.The NAR score was calculated based on the initial clinical stage and postoperative pathological stage,and divided into the low(<8),medium(8-16)and high(>16)layers,respectively.The 3-year disease-free survival(DFS)and overall survival(OS)were calculated using the Kaplan-Meier method,and the differences in DFS and OS among different NAR score layers were compared using the log-rank test.Some patients received consolidation chemotherapy during the interval between concurrent radiotherapy-chemotherapy and surgery,even the total neoadjuvant therapy(TNT)model.Subgroup analysis was further used to verify the predictive value of the NAR score in the strengthened neoadjuvant therapy model.Results The median follow-up of all patients was 46.0 months(range:19.5-88.0 months),the 3-year DFS was 79.2%,and the 3-year OS was 87.4%.Univariate analysis found that the NAR score had a significant impact on the 3-year DFS and OS.The 3-year DFS of patients with low,medium,and high NAR scores were 90.3%,86.1%and 58.7%(P<0.001),and the 3-year OS were 94.4%,91.7%and 74.6%,(P<0.001),respectively.Subgroup analysis showed that the predictive value of the NAR score also applied to the strengthened neoadjuvant therapy model.The 3-year DFS of patients with low,medium,and high NAR scores were 86.9%,83.8%and 68.3%(P=0.044),and the 3-year OS were 92.9%,90.7%and 85.4%(P=0.029),res

关 键 词：直肠肿瘤 局部进展期 新辅助放化疗 全新辅助治疗 预后 

分 类 号：R73[医药卫生—肿瘤]